Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Sep 4:12:127-132.
doi: 10.2147/ORR.S272077. eCollection 2020.

Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report

Ibrahim S Almazrua  1 , Abdullah Y Almarshad  1 , Ghadah Binzuman  2 , Anwar M Alrabiah  1
Affiliations
Case Reports

Psoas Hematoma and Late Femoral Nerve Palsy After Extreme Lateral Interbody Fusion and Posterior Spinal Fusion with Instrumentation: A Case Report

Ibrahim S Almazrua et al. Orthop Res Rev. .

Abstract

Introduction: Psoas hematoma is an uncommon complication following spinal surgeries. It has been reported in both extreme lateral interbody fusion (XLIF) and posterior spinal fusion with instrumentation. Minimally invasive techniques are gaining popularity in recent years due to the appealing advantages of reduced operative time, blood loss, hospital stay, and faster recovery.

Case presentation: We are presenting a case of a 77-year-old male with chronic low back pain, diagnosed to have multilevel degenerative disc disease with central and foraminal disc protrusion at L2-L3, L3-L4, L4-L5 with secondary spinal stenosis, underwent XLIF at L3-L4, L4-L5 and then 2nd stage with posterior L3-L5 fusion with pedicle screws. On the fourth day post-operatively, the patient had flank pain and dropping hemoglobin with femoral nerve palsy symptoms, a CT scan revealed a large psoas hematoma. Conservative management was decided on; a follow-up CT scan and examination showed complete resolution of the hematoma and femoral nerve recovery.

Discussion: The approach to iliopsoas hematoma post spinal surgeries remains controversial. Iliopsoas hematoma should be suspected in any patients post spinal surgeries even with delayed presentations. The decision to proceed with either surgical intervention or conservative management depends on multiple factors, including patient hemodynamic status, progression of collection and femoral nerve palsy.

Conclusion: The exact cause of iliopsoas hematoma post different spinal surgery approaches remains vague. In our opinion, other causes including pre- and post-operative anticoagulants should be investigated. Rushing to drain iliopsoas hematomas in case of femoral nerve palsy might not be the ideal option. Instead, monitoring patient responses to resuscitation and taking a watch and wait approach for femoral nerve palsy might be the proper approach.

Keywords: extreme lateral interbody fusion; XLIF; femoral nerve palsy; posterior spinal fusion; psoas hematoma.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest for this work.

Figures

Figure 1
Figure 1
Pre-operative Anterioposterior (A) and Lateral (B) X-ray of lumbar spine.
Figure 2
Figure 2
Pre-operative MRI of lumbar spine. (A) sagittal, (B) axial Level L4-L5.
Figure 3
Figure 3
Post-operative Anterioposterior (A) and Lateral (B) X-rays of lumbar spine.
Figure 4
Figure 4
Post-operative CT scan showing psoas hematoma (A). Follow-up CT scan at 4 months showing complete resolution of psoas hematoma (B).
See this image and copyright information in PMC

References

    1. Seo JG, Yang JC, Kim TW, Park KH. Intramuscular hematoma on the psoas muscle. Korean J Neurotrauma. 2019;15(2):234–238. doi: 10.13004/kjnt.2019.15.e29 - DOI - PMC - PubMed
    1. Berjano P, Lamartina C. Far lateral approaches (XLIF) in adult scoliosis. Eur Spine J. 2013;22(SUPPL.2):242–253. doi: 10.1007/s00586-012-2426-5 - DOI - PMC - PubMed
    1. Ozgur BM, Aryan HE, Pimenta L, Taylor WR. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior lumbar interbody fusion. Spine J. 2006;6(4):435–443. doi: 10.1016/j.spinee.2005.08.012 - DOI - PubMed
    1. Billinghurst J, Akbarnia BA. Extreme lateral interbody fusion - XLIF. Curr Orthop Pract. 2009;20(3):238–251. doi: 10.1097/BCO.0b013e3181a32ead - DOI
    1. Isaacs RE, Hyde J, Goodrich JA, Rodgers WB, Phillips FM. A prospective, nonrandomized, multicenter evaluation of extreme lateral interbody fusion for the treatment of adult degenerative scoliosis: perioperative outcomes and complications. Spine (Phila Pa 1976). 2010;35(SUPPL. 26S):322–330. doi: 10.1097/BRS.0b013e3182022e04 - DOI - PubMed

Publication types

LinkOut - more resources